High Blood Pressure:
New Light
on a Hidden Killer

Even mild hypertension is likely to be the signal
that a stroke or heart attack 1s on the way. Now science
has learned why, and what to do about it

By LAwRENCE GALTON

iLL Peters is a successful 40-
B year-old executive. Big and
_# brawny, he looks well and
feels fine. Nonetheless, his company
requires him to have regular medi-
cal checkups. At his latest, the doctor
took his blood pressure twice, then
said, “Slightly above normal, Bill.
Not much, but we're still. going to
do something about it.”
Today, more and more doctors are
taking even the mildest hyperten-
sion such as Bill’s seriously. For they
have recently gained important new
insights on this often-neglected, yet
vicious disease. High blood pressure
affects at least 20 million Americans
‘nd is a factor in the deaths of three
.sarters of a million annually. Yet,
says Dr. Joseph A. Wilber of the
Georgia Department of Public

Health, only about 15 percent of
these 20 million victims are receiv-
ing the treatment they need.

Bill Peters is one of the lucky ones.
Because steps were taken to control
his slightly elevated pressure, his
chances of being felled by stroke or
heart disease have been dramatically
reduced.

Most people with hypertension are
unaware of the fact. For the ailment
is stealthy. Most often it produces
no symptoms at all. The Michigan
Heart Association reports that a re-
cent screening program at a large
factory uncovered hypertension in
919 employes—78 percent of whom
did not know they had it. Even
when symptoms occur—such as
headaches, dizziness, fatigue or
weakness—they may not be recog-

65
66 THE READER'S DIGEST

nized for what they are since they
are common to so many other disor-
ders. Moreover, in 85-90 percent of
diagnosed hypertensive patients the
specific cause of the condition can-
not be pinpointed.

Blood pressure is simply the force
exerted by the flowing blood against
the walls of the arteries. Each time
the heart beats, this pressure in-
creases; each time the heart re-
laxes, the pressure decreases. When
a physician checks pressure, he
makes two measurements and writes
them fraction-style, say, as 130/80.
The first and larger figure, 130 milli-
meters (the pressure exerted by a
column of mercury 130 mm. or 5.1
inches high), is the systolic pressure
—the maximum pressure in the ar-
teries when the heart pumps; the
second is diastolic pressure—as the
heart rests between contractions.

Normal pressure may fluctuate
widely, decreasing during sleep, in-
creasing during physical exertion or
emotional excitement, even during
the visit to the doctor. That’s why
many physicians may measure blood
pressure several times in one visit.
And there is a wide range of normal:
100 to 140 for systolic and 60 to go
for diastolic. Nor does an isolated
reading above 140/90 mean ab-
normal pressure. Only when eleva-
tion is continuous does a person
have hypertension.

Hypertension does its harm in
several ways. In one, excessive pres-
sure makes the heart muscle pump
harder, and after a time the heart
enlarges, then it may weaken and

June

fail to pump effectively. This kills
50,000 Americans annually.

Or, as many investigations show,
hypertension may accelerate the
progression of atherosclerosis, in-
volved in coronary heart attacks
which kill some 400,000 Americans
every year. In a 14-year study of
5100 people, ages 30 to 60, in Fram-
ingham, Mass., it was found that
coronary heart disease, with its
heart attacks, was three to five times
more common in people with high
blood pressure. Adding to the in-
dictment, a study by the Health In-
surance Plan of Greater New York
of first heart attacks showed that
twice as many men with pre-exist-
ing hypertension died within a
month as those who had had nor-
mal pressure. Moreover, the hyper-
tensive men who survived the first
attack had twice the risk of recur-
rence and five times the risk of heart
death during the next 444 years.

High blood pressure may con-
tribute to artery-clogging athero-
sclerosis by damaging. blood-vessel
walls, allowing cholesterol and oth-
er materials to nest in the damaged
areas. As these deposits build up,
arteries narrow, and their blood-
carrying capacity is reduced, some-
times even completely blocked.
When this happens to an artery
feeding the brain, stroke results—
200,000 of us die this way each
year.

The Framingham ‘researchers
turned up evidence of the role of
hypertension in stroke. During the
14 years, stroke hit 65 of the men,
1971 HIGH BLOOD PRESSURE: NEW LIGHT ON A HIDDEN KILLER 67

40 of the women. The risk of stroke
proved to be four times as high
among those who had hypertension,
though they had no symptoms, as
among those with normal pressure.
The study brought to light an alto-
gether surprising fact, too. It had
long been assumed that only di-
astolic-pressure elevation is critical,
since that indicates stress when the
heart is supposed to be relaxing. In
fact, some elevation of the systolic
pressure had been regarded as an
innocuous consequence of aging.
“Contrary to popular belief,” says
the Framingham report, “systolic
blood-pressure elevations proved no
less important than diastolic as a
risk factor in stroke.” Indeed, the
findings indicate clearly that hy-
pertension, even of mild degree, at
any age, in either sex, whether sys-
tolic or diastolic, is the most com-
mon and most potent precursor to
strokes,

Fortunately, there is also a posi-
tive side to the recent discoveries. It
has been known for some years that

_ treatment of extremely severe hy-
pertension has dramatic effect on
most patients. But only recently has
there been clear, scientific evidence
of the efficacy of treatment in less
severe hypertension. Working with
17 hospitals across the country, the
Veterans Administration Codper-
ative Study Group, led by Dr.
Edward D. Freis, spent six years
gathering it.

The group reported in 1970 on 380
male patients with mild and mod-
erate hypertension—diastolic pres-

sures g0 to 114, just above the
up-to-go normal range. Some had
been given anti-hypertensive med-
ication, others only symptomatic
treatment and placebo (inactive)
pills of the anti-hypertensive drugs.
In the actively treated group, the
risk of developing heart failure or a
stroke was reduced by two thirds.
‘Twenty untreated patients had to be
placed on anti-hypertensive drugs
because of severely elevated blood
pressures, while this did not occur
in any of the treated men.

Say Dr. Freis and his colleagues:
“The patients we studied differ in
several respects from the general
population—for instance, they start-
ed out with proportionally more
vascular damage. But there is little
doubt that anti-hypertensive treat-
ment proved beneficial.”

The ideal is to bring pressure
down to normal levels and keep it
there. When medication is needed,
the physician adjusts the patient’s
regimen until he finds a drug or a
combination of drugs that will con-
trol pressure effectively with mini-
mal side effects. Often modification
of diet to eliminate extra pounds,
and mild exercise to ease emotional
tension, prove beneficial. Some pa-
tients bring pressure down simply by
reducing the salt in their diets.

To assure adequacy of treatment,
Dr. Irvine H. Page of the Cleveland
Clinic has his patients take their
own readings at home—a practice
easily learned by patients and now
recommended by more and more
physicians, Patients record their
68 THE READER'S DIGEST

pressure, usually when they get up
and again at bedtime, and submit
the readings once a month to the
physician. Says Dr. Page, “At first I
worried that this might make neu-
rotics of some patients, but that has
proved to be exceptionally rare.”

Clearly hypertension stacks up as
a vast health problem —but also as a
momentous opportunity for preven-
tive medicine. “The good news is
that we have found many ways to
treat hypertension,” says Dr. Page.
“And it has been definitely estab-
lished that if blood pressure is kept
within relatively normal limits,
stroke, heart failure and heart at-
tacks are sharply reduced.”

What does all this mean for
you? Simply:

If your physician has told you that
you have mild hypertension, but you
have ignored it, ask him to recheck
you, then follow his advice on bring-
ing pressure down.

If hypertension has never been
diagnosed, recognize that no one is
immune and that pressure may go
up at any time without warning
symptoms, An annual checkup is all .:
the more important now in view of
the new evidence. Making certain
that your blood pressure is—and
stays—in line is one thing you can
do with reasonable ease to reduce
your chances of being crippled or
killed by stroke or heart disease.

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